Na

me:
Jil
l
ianC.
Ramos
. Da
te:
Mar
ch14,
2022

Cour
se/
Yea
r:BS
Nll

CNSI
nfe
cti
on
Vi
rus
esCa
usi
ngCe
ntr
alNe
rvousS
yst
emDi
sea
ses

Vir
use
sar
erespons
ibl
eforc
aus
ings
eve
ral
cent
ral
ner
vouss
yst
emdi
sor
der
ssuc
hasr
abi
es,
enc
epha
li
ti
s,
andmeni
ngi
ti
s.

Cent
ral
ner
vouss
yst
emi
nfec
ti
onsc
aus
edbyv
irus
esc
anc
aus
emeni
ngi
ti
sandenc
epha
li
ti
s.

•
Sympt
omsusua
ll
ysta
rtwi
thf
eve
randc
anpr
ogr
esst
oir
ri
tabi
l
ity
,re
fus
alt
oea
t,he
ada
che
,ne
ckpa
in,
a
ndsomet
ime
sseiz
ures
.

•
Thedi
agnos
isofv
ira
lce
ntr
alne
rvouss
yst
emi
nfe
cti
onsi
sba
sedonas
pina
lta
p.

Ce
ntr
alnervoussys
tem(bra
inandspi
nalc
ord)infe
ctionsar
eextr
emelyse
rious
.Meni
ngit
isa
ffe
ctst
he
membrane
ss ur
roundi
ngthebr
a i
nandspi
nalcord.Encepha
li
ti
saff
ect
sthebrai
nit
sel
f.

Meningi
ti
sisinf
ecti
onofthecer
ebr
alme
ninges
.Iti
scause
dmos tfr
equent
lybybact
eri
ali
nvas
ion.
Chi
l
dr e
nnee dfol
low-upa
fter
wardt
omonitorf
orhear
ingacui
tyandimpai
redsec
ret
ionofant
idi
uret
ic
hor
mone .

E
nc e
phali
ti
sisi
nfl
amma ti
onofbr
ainti
ssue.
Thi
sisal
waysaser
iousdi
agnosi
s,be
caus
ethec
hil
dma
ybe
l
eftwit
hresi
dualneur
ologi
cdamage,
suc ha
ssei
zur
esorle
arni
ngdisa
bil
it
ies
.

Ce
ntr
alne
rvouss
yst
emi
nfe
cti
onsc
aus
edbyba
cte
riaorf
ung
ica
nca
usei
l
lne
sse
ssuc
has
:

•
Bra
ina
bsc
ess
es.

•
Bac
ter
ial
meni
ngi
ti
s.

S
ympt
omsofba
cte
ria
lorf
ung
alc
ent
ral
ner
vouss
yst
emi
nfe
cti
onsma
yinc
lude
:

•
Sev
erehe
ada
che

•
Bac
kpa
in

•
Sti
ffne
ck

•
Conf
usi
on

•
Wea
kne
ss

•
Fev
er

•
Sei
zur
es
•
Par
aly
sis

S
eiz
ure

Asei
z ureisaninv
olunta
rycont
ract
ionofmuscl
ecausedbyabnorma l
elec
tri
calbrai
ndischa r
ge s
.
Approx i
matel
y2%t o3%ofc hi
l
drenwil
lhaveatl
eastonese
izurebytheti
met he yr
eacha dulthood
(Moe, Benke
, &Bernar
d,2008)
.Theseepi
sode
sa r
ea l
waysf
right
eningtoparentsandothe rchil
dre
n
beca
us eoftheintens
it
y.

S
eiz
ure
sint
heI
nfa
nta
ndT
oddl
erPe
riods

Sei
zuresc ommonl yseeninthisa gegr
oupa r
einfanti
lespasms,af ormofg eneral
i
ze dseizure(“sal
aam”
or“jac
kk nif
e ”)
,orinfanti
lemyoc loni
cs ei
zures
.T hesearechar
ac teri
zedbyv eryra
pidmov eme ntsofthe
tr
unkwi ths uddens t
rongc ontracti
onsofmos toft hebody,i
ncludingflex
iona ndadduc t
ionoft heli
mbs .
Theinfants uddenlysl
umpsf orwa r
dfromas itt
ingpositi
onorfallsfr
omas tandi
ngpos it
ion.
Approxima tel
y90%ofi nfant
swi ththi
st y
peofi nvolve
me ntwil
l bede vel
opme ntal
lyde l
ay e
da s
i
ntell
ectua ldevel
opme ntappearstoha l
ta ndeve nregr
essaft
ert hepa t
ternofseiz
ur esbe gi
ns.Most
chi
ldrenwi thinfanti
l
es pasmss howhi gh-ampli
tudes l
owwa vesa ndspikes,achaoticdischargecal
led
hypsar
rhy thmia,ona nE EGtracing.

Febril
eSe i
zures
.Seiz
uresassoci
atedwi t
hhighf ever(102°to104°F[ 38.9°to40.0°C])arethemos t
commont ypeseeninpreschoolchil
dren(5mont hst o5y ears)
,alt
hought hesecanoc curasea r
lyas3
mont hsora sl
ateas7y ear
sofa ge.Febr
il
es ei
zuresma yoccurafte
rimmuni zati
onbe causeofa n
accompa nyi
ngfever.Sei
zuresshowa nacti
vet onic
– cl
onicpa tt
ern,whic
hl ast
sfor15t o20s econds.The
EEGt ra
cingusuall
yisnorma l
.Thereusuall
yisahi s
toryofot herfamilyme mbershavingha dsi
mi l
ar
sei
zures.Febri
lesei
zuresusual
lyoccurduet oas udde nspik
eoft empe r
a t
ure.Thes e
izureonlylast
s1t o
2mi nutesorless
.Suchseiz
uresmus tbet a
ke nseri
ous l
y ,
howe ver,andinvesti
gatedforapos si
blecause,
becauseme ningi
ti
softenma nif
estsi
niti
all
ywi t
hhi ghfevera ndaseizur
e( Middlet
on, 2008).

Di
agnos
isofCe
ntr
alNe
rvousS
yst
emI
nfe
cti
ons

T
hedoctorwi
l
lex
ami
ney
ourc
hil
dandl
ookf
ors
ignsa
nds
ympt
omsofaCNSi
nfe
cti
on.
Tes
ti
ngma
y
i
ncl
ude
:

-
Bloodt
est
s.

-
Comput
edt
omog
rapg
y(CT
)orma
gne
ticr
esona
ncei
mag
ing(
MRI
).

-
Spi
nal
tap.
Tre
atme ntforCNSinfe
c t
ionsvari
esdepe ndingonthetypeofi nfect
ion,t
he
l
ocati
onoft heinfec
ti
ona ndyourchil
d’sov eral
lheal
th.Forbac t
e r
ialorf
ung
al
CNSinfe
c t
ions,tr
eatmentma yincl
udea ntibi
oti
cs,i
ntra
ve nous(IV)fl
uids
,
anti
convuls
a nt
sforsei
zuresandster
oidsf orbrai
nswe l
li
ng .

T
hes peci
fi
cme dic
a t
ionsgi
ventoaninf
antwi
thaCNSi
nfecti
onwil
ldependon
t
hetypea ndseveri
tyoftheinf
ect
ion.I
ngene
ral
,medi
cat
ionsgi
venforCNS
i
nfe
ctionsini
nfantsma yi
ncl
ude:
Anti
biot
ic
s:Anti
bioti
csareusedt
otre
atbact
eri
ali
nfe
cti
onsoft
heCNS,sucha
sme ni
ngi
ti
s.The
choi
ceofanti
bi
oticwill
de pe
ndonthespe
cif
icbac
ter
iaca
usi
ngthei
nfe
ctionandt
heinf
ant'
s
ageandme di
calhis
tory
.

Ant
ivi
ral
s:Ant
ivi
ral
me di
cat
ionsa
reusedtotre
atvi
ral
inf
ect
ionsoft
heCNS
,suc
hashe
rpe
s
enc
ephali
ti
sorcongeni
tal
cytomega
lov
irusi
nfec
ti
on.

Anti
funga
ls:
Ant
if
ungalmedi
cat
ionsa
reus
edt
otr
eatf
ung
ali
nfe
cti
onsoft
heCNS
,suc
has
cr
yptococ
calme
ning
iti
s.

Ant
ic
onvuls
ant
s:I
nfa
ntswi
thCNSinf
ect
ionsmayexpe
rie
nces
eiz
ure
s,a
nda
nti
conv
uls
ant
medi
cat
ionsar
eusedtopr
eventa
ndtre
a ts
eiz
ure
s.

Pai
nmedi
cat
ion:
Inf
ant
swithCNSi
nfe
cti
onsmaye
xpe
rie
ncehe
ada
che
sandot
hert
ype
sofpa
in,
andme
dic
ati
oncanbegiv
entomanagepai
n.

I
tisimpor
tanttonotethatme di
cat
iondosa
g e
sa ndtreat
me ntpl
answil
lbedet
ermine
dbyt
he
i
nfant'
sheal
thc
a r
eproviderandwil
lvar
yde pendingonthespeci
fi
ctypeofi
nfe
cti
on,t
he
i
nfant'
sag
ea ndme di
calhist
ory,
andotheri
ndividualf
actor
s.
NURSI
NGDIAGNOSI
S
•Ther
is
kfori
nj
uryr
ela
tedt
othei
nte
rna
lfa
ctor
sofa
lte
redne
urol
ogi
cre
gul
ator
yfunc
ti
on.

•Def
ic
ientknowl
edgere
lat
edtola
ckofex
posur
etoinf
orma
tionasevi
dence
dbyr
eque
stf
or
i
nfor
ma t
ionaboutmedi
cat
ions
,si
gnsa
ndsymptoms
, a
ndbehavi
orst
oreport
.

•
Impa
ire
dphy
sic
almobi
l
ityr
ela
tedt
oCNSi
nfe
cti
ona
sev
ide
nce
dbydi
ff
ic
ult
ype
rfor
mingADL
s.

T
heri
skf
ori
nj
uryr
ela
tedt
othei
nte
rna
lfa
ctor
sofa
lte
redne
urol
ogi
cre
gul
ator
y
f
unc
ti
on.
Nur
si
ngMa
nag
ement

Monitorv
ital
sig
ns:Fr
equentmoni
tor
ingofvi
tal
signss
uchastempe
rat
ure,hear
tra
te,andbl
ood
pres
surecanhelpde
tectc
hangest
hatmayindi
cateaworse
ningoft
heinf
ecti
onorthedevel
opmentof
compli
cat
ions.

Asses
sneurol
ogi
calfunct
ion:As
ses
singneurologi
cal
funct
ionre
gul
arl
ycanhe
lpdet
ectanycha
ngesi
n
thei
nfant
'sle
velofconsc
iousne
ss,
mot orfuncti
on,r
efl
exes,
andre
spons
etosti
mul
i.Thi
sca
nhe l
p
dete
ctanydeter
iora
tioninthei
nfa
nt'scondit
ion.

I
mplementseiz
ureprecauti
ons:I
nfa
ntswit
hCNSinf
ecti
onsa
reatr
is
kfors
eiz
ure
s. I
mpl
ementi
ngs
eiz
ure
pr
eca
ut i
onssuchaspaddingthesi
derai
l
softhec
ribandmai
nta
ini
ngaqui
etenvi
ronmentc
anhel
p
pr
eventinj
urydur
ingase i
zur
e .

Admini
st
e rmedica
tion:Admini
ster
inga
nti
biotic
s,ant
ivi
ral
s,ora
nti
fung
almedi
cat
ionsa
spr
esc
ribe
dca
n
hel
ptreattheunderl
yinginf
ect
ionandpre
ve ntfur
therdamagetot
heCNS.

Mai
nta
inhydr
ati
onandnutr
it
ion:
Ens
uri
ngthatthei
nfantr
ece
ivesa
dequa
tehy
dra
tiona
ndnut
ri
ti
on
c
anhel
psupportt
hebody'
simmuneres
ponseandpromoteheal
i
ng.

Prov
ideaca
lmandcomfort
inge
nvir
onment:Aca
lma
ndc
omf
ort
inge
nvi
ronme
ntc
anhe
lpr
educ
est
res
s
andpromot
ere
st,whi
chisi
mporta
ntforhe
ali
ng.

Educatethepar
ent
s:Educa
tingt
heparent
sonthesi
gnsa
ndsympt
omsofwor
seningi
nfec
tion,
me di
cati
onadmini
st
rati
on,andsei
zur
epreca
uti
onsc
anhelpe
nsur
etha
tthei
nfa
ntrecei
vesappropr
iat
e
car
ea ndpreve
ntcompli
cat
ions.
Defi
ci
entknowle
dgerel
ate
dtola
ckofexposur
etoinf
ormat
iona
se v
ide
ncedby
re
questfori
nfor
mati
onaboutmedi
cat
ions,
sig
nsandsympt
oms,andbeha
vior
sto
re
port.
Nur
si
ngMa
nag
ement

Ass
esst
hepar
ent'
sle
vel
ofunde
rsta
ndingandknowl
edg
ea boutthei
nfa
nt'
scondi
ti
on.As
kopen-e
nde
d
ques
ti
onst
odete
rminet
hei
rcur
rentunder
standi
nga
ndcla
r i
fyanymi
sconc
epti
onsthe
yma yha
ve.

Provi
det
hepa r
entwit
hwr i
tt
enandv
erbali
nfor
mati
onabouttheinf
ant
'scondi
tion,
incl
udi
ngthesi
gns
andsymptomsofthei
nfe
cti
on,t
hemedic
ati
onspre
scri
bed,a
nda nypot
e nt
ial
sideeff
ect
soradver
se
reac
ti
ons.

Prov
ideeduca
tionaboutthei
mporta
nceofmedi
cat
ioncompl
ianc
e,t
hedos
age
sanda
dmi
ni
st
rat
ion
ti
mes,andhowt oproper
lyst
orea
nddispos
eofmedic
ati
ons.

Tea
chthepa
renthowtomoni
tortheinf
ant
'svit
a l
sig
nsandothers
ymptomsthatmayi
ndica
tea
wors
eni
ngofthei
nfe
cti
on.
Advis
et he
mt or
e portanycha
ngesimmedi
atel
ytothehe
a l
thc
arepr
ovi
der
.

I
nst
ructthepare
ntonproperi
nfe
cti
onpre
vent
ionmeasur
es,
suc
hasha
ndhy
gie
nea
ndi
sol
ati
on
pr
ecauti
ons,t
omi ni
miz
etheri
skofi
nfe
cti
ontr
ansmi
ssi
on.

Provi
deemot
ionals
upportt
othepare
nt,a
stheymaybeanxi
ousorov
erwhel
medbytheinf
ant
's
condi
ti
on.Of
ferc
ounsel
ingandr
esourc
estohe
lpthe
mc opewit
hthest
res
sofca
ringf
orasi
cki
nfant
.

Ens
urethatt
hepar
enthasa
c ce
sstor
eli
abl
esour
cesofi
nfor
mat
iona
nds
uppor
t,s
ucha
sanur
se
hel
pl
ineoronl
ines
uppor
tgroups.
I
mpa i
redphysi
calmobi
l
ityr
ela
tedt
oCNSi
nfe
cti
ona
sev
ide
nce
dbydi
ff
ic
ult
y
per
for
mi ngADLs.
Nur
si
ngMa
nag
ement

Assess
me nt
:Ass
esstheinf
ant
'smobi
li
tyst
atus
,inc
ludi
ngthe
ira
bil
it
ytomovet
hei
rli
mbs,st
rength,
coordi
nati
on,ba
lanc
e ,
andrangeofmoti
on.Al
so,ass
esst
hepre
senceofa
nypa
inordi
scomfortt
hat
mightli
mitmovement.

Posi
ti
oni
ng:Posi
tiontheinf
antpr
operl
yiscr
uci
altopr
omotemobil
it
ya ndpreventc
ompli
cati
onssuch
ascont
rac
turesandpr e
ssur
eulcer
s.T
henurseshoul
densur
ethei
nfantisposi
ti
onedinacomfort
able
andsaf
eposit
iont ha
tpromotesmobi
li
ty,s
uchasonthei
rbackwi
ththeirar
msa ndl
egssl
i
g ht
lyf
lexe
d.

RangeofMoti
onExer
cis
es:Rangeofmoti
one x
erc
isesc
anhel
pma i
nta
inj
ointmobil
it
y ,
prevent
cont
ract
ure
s,andpr
omot ecir
cul
ati
on.Pe
rfor
mg ent
lera
ngeofmot
ionex
ercis
esfortheinf
ant'
sli
mbsa
s
pres
cri
bedbythehe
alt
hca r
eprovi
der.

As
sis
ti
veDev
ices
:Provi
dea
ssi
sti
vedev
ice
s,s
uchasbr
acesorspl
i
nts,
tosuppor
ttheinf
ant
'sl
imbsa
nd
pr
omotemobil
i
ty.The
sedevi
cess
houl
dbeprope
rlyf
it
tedandusedacc
ordi
ngtotheheal
thc
are
pr
ovi
der'
sor
ders.

Pa
inMana
gement:
As s
essa
ndma nag
epa i
nrel
atedt
otheCNSi
nfe
cti
ona
ndi
mpa
ire
dphy
sic
almobi
l
ity
.
Pa
inc
anli
mitmobi
li
tyandaf
fec
ttheinf
ant'
sabi
l
ityt
operf
ormADLs.

Fa
milyE
ducati
on:Educ
atethei
nfa
nt'sf
amil
yonpr
ope
rposi
ti
oni
ng,
rang
eofmot i
onexe
rci
ses
,andt
he
us
eofassi
st
ivedev
ices
.Als
o,te
achthefami
lyt
ore
cog
niz
esi
gnsofc
ompli
cat
ionssuc
haspres
sur
e
ul
cer
sandcontr
act
ures.

Col
labora
tewitht
heheal
thc
areteam:
Coll
aboratewit
htheheal
thc
arete
amtodevel
opa
comprehens
ivepl
anofc
arethata
ddres
sestheinfa
nt'
smobil
i
tyneeds
.Thepl
anofc
ares
houl
dbe
reg
ularl
yeval
uate
dandmodifi
edasnec
essa
r y
.
ANATOMYANDPHYS
IOL
OGYOFTHENERVOUSS
YSTEM
Ne rvec ell
s( neur ons )a reuni quea mongbodyc ell
sint ha t,inste adofbe ingc ompa ct,the ycons is
tofa
cellnuc l
eusa nde xte ns i
ons : onea xona nds ev e r
a lde ndr ite s
. Thede ndr i
tet rans mi tsi mpul s
e stothec el
l
nuc l
e us ;thea xont ra ns mi t
si mpul se sa wa yf romt hec e l
l nuc l
e ust obodyor ga ns .T he sec ell
sv aryins ize,
rang i
ngf romaf ewi nc he stos eve ral feetlong ,re achingf romdi stantbodys ite ss uc ha st hefe et,throug h
thes pina lc ord, andt ot hebr a i
n. Alt houg ht he i
rg rea tle ng thisv it
a lt omot ora nds e nsor yfunc ti
on, i
t
alsoma kesne rvec e l
lsmor es us cept ibletha not he rbodyc ell
st oinj ur y.Thene rv ouss ystemc onti
nue sto
ma tur et hroug ht hef irst12y e arsofl ife.I
ta ctua l
lyc ons i
st soft wos e pa rates ys tems :thepe ri
phe ral
nerv ouss ystem( PNS )a ndt hec e ntra lne r
v ouss ystem( CNS )
. ThePNSc ons istsoft hec ranialne rves,the
spina lne rve s,andt hes oma tica ndv isceral divisions .T hev isceraldi visioni nc l
ude st hea utonomi cs ystem.
TheCNSc ons istsoft hebr ain, thes pi nal cord, a ndt hes ur roundi ngme mbr ane sorme ni
ng est hatpr otect
thebr aina nds pina lc ordf romnor ma lt
rauma . Theset issue sa rea lsopr otec tedbyt hes kull
, the
verte bral column, a ndt hec e rebr os pina lfl
ui d( CS F)
, thef luidint hes uba r
a chnoi ds pa ce, whichs erv esas
ac ushi on. Be caus ebr ainpr ot ec t
ioni ssoi mpor tant,thebr ainisc ov e re dbyt hre es e pa r
a teme mbr ane s
:
thedur ama ter(af ibr ous ,conne c ti
v et i
ssuec ont a i
ningma nybl oodv es sel
s), thea ra chnoi dme mbr ane( a
delicates erousme mbr a ne), andt hepi ama ter( av as cula rme mbr a ne )( Fig.49. 1). Fourf l
uid-fill
ed
cavities,orv ent ri
cle s, l
iewi thi nt hebr ain( Fig. 49.2). CS Ff ormsi nt het wol at era lve ntr i
clesint he
chor oidpl ex usoft hepi ama tera ndf lowst hr oug ht hef or ame nofMonr oi ntot het hirdv entricl
e, then
throug hana r
rowc a na l(thea que duc tofS ylvius)t ot hef our t
hv ent ri
c le.Itlea ve st hef our thv entri
c l
eby
thef ora me nofMa g endi ea ndt het wof orame nsofL us c hk aa ndf lowsi nt othec i
s ternama gna ,a
collectionpool att heba seoft hes kul l
.Fromt hec i
ste rnama gna ,thef luidc ircula test ot hes uba rachnoid
spa ce, bathi ngbot ht hebr aina ndt hes pina lc ord. Thef luidi sthe na bs orbe dbyt hea rachnoi d
me mbr ane . Thet imes pa nforr epl ace me nti sa ppr ox i
ma t ely6hour s.T hepr ope r ti
e sofCS Fa reshowni n
Table49. 1. Itisba sica ll
yac ol orles s
, a l
ka l
inef luidwi thas pe ci
ficgr av i
tyofa ppr ox i
ma tely1.004t o1.008,
cont ainingt r a
c esofpr ote i
n, g l
uc ose , l
ymphoc y tes,andbodys alts.T hef l
uidc i
rc ulat esdownwa rdt ot he
l
e vel ofthes e
c onds a cral v
e rte bra( S 2).Ininf ant s,thes pina lcor de ndsa tthet hir dlumba rve rt
ebr a(L3);
i
na dole scent sa nda dul ts,atL 1orL 2. Thisc onf igur ationl e avesas pa c ene art hec ordba sec ont ai
ning
CSFt ha tc anbet appe ds a f
e l
y( lumba rpunc tur e)wi thoutf earofc a us ings pina l cor dda ma ge.